Korean J Orthod.  2018 Mar;48(2):125-130. 10.4041/kjod.2018.48.2.125.

Autotransplantation: A biological treatment alternative for a patient after traumatic dental injury

Affiliations
  • 1Division of Orthodontics, School of Dental Medicine, University of Connecticut, Farmington, CT, USA. minnie.vishwanath@unmc.edu
  • 2Department of Growth and Development, Orthodontic Section, College of Dentistry, University of Nebraska Medical Center, Lincoln, NE, USA.
  • 3Division of Orthodontics, School of Dentistry, University of Louisville, Louisville, KY, USA.
  • 4Private Practice, Spring, TX, USA.

Abstract

Traumatic dental injury is considered a public dental health problem because of a high childhood incidence, high treatment costs, and prolonged treatment time. Although management guidelines for traumatized teeth have been outlined, tooth loss following trauma is occasionally unavoidable. Here, we describe the successful interdisciplinary management of a traumatized central incisor in an 11-year old boy that was extracted because of a poor prognosis and restored by the autotransplantation of an immature donor tooth into the site. The patient underwent orthodontic treatment in order to close the donor site space and bring the autotransplanted tooth to an ideal position. Postorthodontic treatment radiographs and photographs revealed an esthetic and functional natural tooth replacing the lost tooth. The findings from this case suggest that autotransplantation offers unique advantages as a treatment modality for the restoration of missing teeth, particularly in growing children.

Keyword

Transplantation; Orthodontic mini-implant; Growth and development; Dental trauma; Autotransplantation

MeSH Terms

Autografts*
Child
Growth and Development
Health Care Costs
Humans
Incidence
Incisor
Male
Prognosis
Tissue Donors
Tooth
Tooth Loss
Transplantation
Transplantation, Autologous*

Figure

  • Figure 1 Pretreatment photographs and imaging findings for an 11-year-old boy with a traumatized maxillary central incisor. A, Intraoral photograph shows the crown of the maxillary right central incisor with a vertical fracture line extending onto the labial surface. B, Intraoral photograph shows the crown of the maxillary right central incisor with a vertical fracture line extending onto the palatal surface. C, Cone-beam computed tomography (CBCT) reveals the presence of a horizontal fracture at the cementoenamel junction/coronal portion of the root of the maxillary right central incisor. D, A panoramic radiograph reconstructed from the CBCT data reveals the presence of a vertical crown fracture as well as the root morphology and developmental stage of the mandibular right second premolar.

  • Figure 2 Extraction and autotransplantation of the fractured maxillary central incisor. A, Atraumatic extraction of the mandibular right second premolar (donor tooth). B, Autotransplantation of the mandibular right second premolar into the socket of the maxillary right central incisor. The autotransplanted tooth is splinted to the adjacent incisors using a 0.020-inch stainless steel wire. C, Pretreatment panoramic radiograph shows alveolar bone remodeling around the autotransplanted tooth (tooth #45 in the socket of tooth #11) and the edentulous space of the donor tooth. D, A stereolithographic model of the donor tooth.

  • Figure 3 Orthodontic treatment in progress. A, Autotransplanted tooth bonded and aligned with the contralateral central incisor. B, A temporary anchorage device is placed on the ridge for closure of the donor space through protraction of the right mandibular molar. C, Maxillary arch held passively to allow for eruption of maxillary canines bilaterally. Space closure in progress in the mandibular arch.

  • Figure 4 Intraoral photographs and a panoramic radiograph obtained after autotransplantation and orthodontic treatment. A, Intraoral photographs show functional occlusion and the postrestorative findings for the autotransplanted tooth (tooth #45 in the socket of tooth #11). B, Post-treatment panoramic radiograph showing complete root formation of the autotransplanted tooth.


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